5 Steps to Becoming a Skilled Vestibular Clinician

Are you looking to provide best practice care for patients with vertigo, dizziness, or imbalance? Vestibular assessment and/or care is currently being provided by clinicians in the following licensed professions:

  • Physicians
  • Audiologists
  • Physical and Occupational Therapists
  • Physical and Occupational Therapist Assistants
  • Chiropractors/Functional Neurologists
  • Physician Assistants, Nurse Practitioners, and RNs

How you go about becoming a vestibular specialist will depend on your previous training, patient population, and scope of practice for your specific degree and practice.

Here are 5 steps that can guide your progress from novice to expert status!

1. Establish Current Experience Level

To get where you are going, you need to know where you stand today. If you can answer yes to any of the following in a single group, then you likely qualify for that group:

Basic

  • I did not get any vestibular training in school
  • I have attended less than 12 hours (including labs) of vestibular education
  • It has been more than 3 years since I had a semester or weekend basic vestibular course AND since then I have had limited experience caring for patients with vestibular issues
  • I have attended more than one vestibular course, but I have very limited or no experience working with vestibular patients

Intermediate

  • I had a full semester or more in school focused solely on vestibular topics within the past 3 years and have been caring for vestibular patients regularly
  • I have taken at least one basic weekend or week-long vestibular course and see at least 2 vestibular patients a week on average

Advanced

  • I have taken at least four continuing education vestibular courses that covered a variety of patient populations (basic, concussion, cervicogenic dizziness, etc.) AND I have worked with vestibular patients regularly for at least 5 years
  • I have passed both the Duke University competency based course and the Duke competency based renewal course

2. Take Vestibular Courses

Anatomy, exam techniques, and treatment options are the solid foundations of knowledge that you’ll want to master. The anatomy is particularly important and should be thoroughly covered in your first course. Does your course of interest measure up? Based the International Guidelines for Education in Vestibular Rehabilitation Therapy, an intro course should cover evidence-based information about:

  • Basic Science – Inner ear anatomy, physiology, sensory systems and integration, vestibular neural pathways (peripheral to central), etc.
  • Clinical Science – Etiology, pathophysiology, epidemiology, prognosis, and potential medical or clinical interventions for vestibular conditions, differential diagnosis, cognitive/psychological comorbidities, etc.
  • Specific Assessment Skills – Oculomotor exam, positional testing for BPPV, balance testing, subjective visual vertical, scales and self-assessments for patients to rate symptoms and functional issues, dynamic visual acuity testing, etc.
  • Specific Treatment Skills – BPPV maneuvers, gaze stabilization and substitution exercises, habituation, balance and gait training, patient education on footwear, eye care, and environmental adaptations for safety, and appropriate frequency, duration, and individualization of plan of care and home exercise programs, etc.

Note: There is no such thing as an official Vestibular Certification for physical therapists, although individual courses can “certify” you on their personal techniques. As the APTA’s Academy of Neurologic Physical Therapy states, “Currently the APTA does not offer a certification process for physical therapists in Vestibular Rehabilitation.

As a resource, a list of course providers and conferences that cover basic, intermediate, and advanced level vestibular topics has been compiled to support your educational planning. It is highly recommended to take an in-person course for your first course to ensure you receive direct feedback regarding hands-on examination skills.

The course providers listed below are consistently rated as strong courses for physical therapists, but of course you can always read reviews and ask other trusted vestibular clinicians in your field about their recommendations as well:

  • APTA
  • Duke
  • Education Resources Inc.,
  • Emory University
  • Healthclick
  • International Vestibular Conference
  • Skillworks
  • Vestibular Seminars

Vestibular Course Providers

OrganizationCourse TopicsFormatLevelCredentials
360 Neuro HealthRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT; Aud
American Academy of AudiologyHealthcareConferenceBasic; IntermediateAud
American Academy of OtolaryngologyHealthcareConferenceIntermediate; AdvancedMD; DO
American Institute of BalanceRehabilitation; Concussion; CervicogenicOnline Courses; In-Person CoursesBasic; IntermediatePT; Aud; MD; DO; PA; NP; OT
APTA - Academy of Neurologic Physical TherapyRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT
APTA - Academy of Neurologic Physical Therapy ConferenceRehabilitation; Concussion; PediatricOnline CoursesBasic; Intermediate; AdvancedPT; PTA
APTA - Combined Sections MeetingRehabilitation; Concussion; PediatricIn-Person CoursesIntermediate; AdvancedPT
APTA - University of PittsburghRehabilitationIn-Person CoursesIntermediate; AdvancedPT; OT; MD; DO; Aud; PA; NP
Association of Migraine DisordersHealthcareConferenceIntermediate; AdvancedMD; DO; PA; NP
Audiology OnlineHealthcareOnline CoursesBasic; Intermediate; AdvancedAud
Carrick InstituteChiropractic CareIn-Person CoursesBasic; Intermediate; AdvancedDC
Combined Otolaryngolgy Spring MeetingsHealthcareIn-Person CoursesIntermediateMD; DO
Dizziness and Balance Rehabilitation Clinic in CanadaRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; AdvancedPT; OT; MD; DO; DC
Education Resources, Inc.Rehabilitation; Concussion; Cervicogenic; PediatricIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA; Aud
Elite Rehabilitation SolutionsRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; IntermediatePT
Emory University Competency Based CourseRehabilitationIn-Person CoursesIntermediate; AdvancedPT; OT; MD; DO
EvidenceCEURehabilitation; Concussion; CervicogenicIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; PTA
Functional Neurology SeminarsChiropractic CareOnline CoursesIntermediate; AdvancedDC
Great Lakes SeminarsRehabilitationIn-Person CoursesBasicPT
Healing VertigoRehabilitation; ConcussionOnline CoursesBasic; IntermediatePT; OT; Aud
HealthclickRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA
International Association of Functional Neurology and RehabilitationChiropractic CareConferenceBasic; Intermediate; AdvancedDC
International Symposium on Clinical NeuroscienceChiropractic CareConferenceIntermediate; AdvancedDC
International Vestibular ConferenceHealthcare; RehabilitationConferenceIntermediate; AdvancedPT
Johns Hopkins MedicineHealthcareIn-Person CoursesAdvancedMD; DO
Mayo School of Continuous Professional DevelopmentHealthcareConferenceIntermediate; AdvancedMD; DO
MedbridgeRehabilitationOnline CoursesBasic; IntermediatePT; PTA; OT; OTA
Motivations, Inc.Rehabilitation; PediatricIn-Person CoursesBasic; IntermediatePT; PTA; OT
Noesis Therapy SeminarsConcussion; RehabilitationIn-Person Courses; Online CoursesBasic; Intermediate; AdvancedPT; OT; DC; Aud; PA; PTA; OTA
North 49 TherapyRehabilitationOnline Courses; In-Person CoursesBasic; IntermediatePT
OTcourses.comRehabilitationOnline CoursesBasic; Intermediate; AdvancedOT; OTA
PESI RehabRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA; MD; DO; Aud
Posture and Balance ConceptsRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
Shirley Ryan Ability Lab AcademyRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
Skill WorksRehabilitation; CervicogenicIn-Person CoursesBasic; IntermediatePT
Specialty TherapyRehabilitation; PediatricIn-Person CoursesBasic; Intermediate; AdvancedPT; PTA; OT; OTA
St. Joseph's/Candlar Center for Oto-NeurologyHealthcareIn-Person Courses; Online CoursesIntermediateMD; DO; Aud
Summit Professional EducationRehabilitationOnline CoursesBasicPT; PTA; OT; OTA
Therapy InsightsRehabilitationOnline CoursesBasic; IntermediatePT; OT; OTA; PTA
Therapy Network SeminarsRehabilitationIn-Person CoursesBasic; IntermediatePT; PTA; OT; OTA
University of ManchesterHealthcareOnline CoursesIntermediate; AdvancedAud
University of PittsburghRehabilitation; Concussion; CervicogenicOnline Courses; In-Person CoursesAdvancedPT
Vestibular TodayRehabilitationIn-Person Courses; Online CoursesBasic; IntermediatePT; PTA; OT; OTA; Aud

3. Find a mentor or “Board of Directors”

In order to get guidance as you examine and treat patients with dizziness, you will want to find an experienced clinician to mentor you, likely from your same discipline if available. You can have 3-5 mentors, also known as your “board of directors,” who you can email, call, or video chat with questions that arise as you see more patients with dizziness and imbalance. If mentors are not available within your organization, useful ways to find them can include:

  • Local vestibular clinicians in the Vestibular Disorders Association
  • Contact the largest hospital networks in your area that have vestibular therapists or a balance center to ask about potential mentorship or vestibular education groups for clinicians in the region
  • Vestibular course instructors and lab assistants
  • Specialty section websites
  • Discipline-specific mentorship programs such as the Clinical Mentorship Program through the Academy of Neurologic Physical Therapy

4. Get experience examining patients with the proper tools

Once you’ve gained knowledge by taking coursework, it is essential to get experience working with vestibular patients. A critical part of a vestibular exam is watching eye movements during the oculomotor and positional testing portions. Some of these tests should be done with visual fixation removed (in the dark) to maximize the likelihood of visualizing and recording any abnormal eye movements. Baba et al. (2004) found that if you are using traditional thickened lens Frenzels instead of infrared video goggles (video Frenzels) to view eye movements in the dark, you can miss 66% or more of abnormal eye movements in patients with vestibular pathology. Other important tools can include a tape measure or accommodation ruler to measure convergence, an eye chart for measuring dynamic visual acuity, and an eye occluder for testing for skew deviations. For a helpful list of tools, check out our Essential Equipment for a Vestibular Rehabilitation Clinic.

5. Keep connected for advanced skills and knowledge building

Choose as many resources below as you can to keep your vestibular care fresh, current, and evidence-based and to maximize your connections with leaders in the field:

The field of vestibular care is fascinating in its complexity, rewarding in its ability to literally change the lives of clients who receive quality care, and challenging in its constant evolution of new techniques for evidence based examination and treatment. Should you choose to move forward on your journey to become an experienced vestibular clinician, we applaud and welcome you to this grand adventure. Gaining these skills requires dedication and time, but when done well, it is completely worth the effort!

Questions? Have more tips to recommend? Contact helena@vestibularfirst.com!